Career Summary

Biography

Dr Nicole M Ryan is a part-time NHMRC Early Career Research Fellow within the Clinical Toxicology Research Centre at The University of Newcastle. The Clinical Toxicology Research Group focuses on improving the understanding of poisoning and envenoming in patients and undertaking studies to determine the effectiveness of antidotes and antivenoms in the treatment of these conditions. Aside from the clinical trials that Dr Ryan leads within the Clinical Toxicology Research Group she also conducts regular ED clinician information and training sessions on the implementation and conduct of these trials within the various research hospital sites. Notably, Dr Ryan’s current toxicology research and earlier refractory cough research have been successfully translated into clinical practice and guidelines.

Dr Ryan is current Convener of the Australian Society for Medical Research (ASMR) Hunter Region Committee for 2016 and 2017 and prior to that co-convener of the Newcastle ASMR 2015 Satellite Scientific Meeting held at HMRI. In conjunction with the Sydney ASMR Committee Convener Dr Ryan continues to raise the profile and importance of ASMR through the recent award of the NSW Government Office of Health and Medical Research Sponsorship of the ASMR Sydney and Newcastle Medical Research Week events for 2017.

Dr Ryan has recently been an invited expert reviewer for the Australian Academy of Science, NOVA: Science for Curious Minds on Venom, a University of Newcastle (UON) undergraduate exam marker and school PhD Confirmation Chair. Dr Ryan represented Early Career Researchers at the Science Pathways 2016: Future Leaders Forum at the UNSW. Dr Ryan has peer-reviewed for ten national and international medical journals within her areas of expertise as well as protocol review for the Dr Hadwen Trust for Humane Research in London. Prior to Dr Ryan’s current post-doctorate appointment in the Clinical Toxicology Research Group she held a NHMRC CCRE PhD scholarship and a post-doctorate position at the Priority Research Centre for Asthma and Respiratory Disease, University of Newcastle and the Hunter Medical Research Institute for 10 years. Dr Ryan has been an invited panel member and advisor at the School’s Thesis by Publication Workshops and was one of the first UON PhD candidates to complete her thesis by publication. For this thesis Dr Ryan was awarded the Faculty of Health & Medicine Research Higher Degree Excellence Award in 2012.

Research Expertise

Dr Ryan’s present and past research has investigated and continues to evolve around neuropathic disorders, where she continues to study their aetiology, mechanisms and investigation of pharmacotherapy treatment trials. Her current research on red-back spider bite envenomation with alternate analgesia such as with medications normally used for neuropathic pain will result in significantly improved ED treatment. Dr Ryan’s research on improving snake bite treatment such as with early antivenom administration and the prophylactic use of corticosteroids for serum sickness are multi-centre randomised placebo controlled-studies that also have the potential to transform treatment for snakebite. These studies form an integral part of the Clinical Toxicology Research Group’s NHMRC CRE for Venom and Antivenom Translation.

Teaching Expertise

Dr Ryan is a co-supervisor of two PhD candidates in the areas of clinical toxinology, toxicology and pharmacology. One of these candidates is examining antidotes and treatments in overdose. This will result in evidence-based management for intensivists and Poisons Information consultants, and best practice guidelines for treatment of medication overdose. Dr Ryan’s other PhD student focuses on the myotoxic effects from Australian and Sri Lankan snakebite. This work builds on a successful collaboration between the Newcastle Clinical Toxicology Research Group and the South Asian Clinical Toxicology Research Collaboration based in Sri Lanka. This research has global significance as snakebite is a recognised WHO Neglected Disease.

Research Advantage Early Career Researcher Equipment Grant 2016 for ‘Frimed Laboratory Freezer with Alarm’. This freezer is used to store research blood samples related to the CI’s research program including patient samples from the Australian Snakebite Project (ASP), the Australian Toxicology Monitoring Study (ATOM) and the international multi-institutional CRE in Venom and Antivenom Translational Research projects.

Funding body: The University of Newcastle - Research and Innovation Division

NHMRC Translational Australian Clinical Toxicology (TACT) Program, Training and Travel Support Scheme for attendance and presentation at the 15th International Scientific Conference of the Asia Pacific Medical Association of Medical Toxicology (APAMT) 2016, Singapore 17â20 November 2016.

Research Projects

ATOM Studies: Pregabalin, Gabapentin Toxicity Project 2015 -

The aim of this project is to investigate the toxic effects and pharmacokinetics of pregabalin and gabapentin in overdose.

Investigating the QT Interval in a Normal Population 2015 -

The objectives of this study are to:

Investigate the QT interval in a normal population including individual QT variabilityÍ¾

Investigate the relationship between QT and heart rate (RR interval) for individuals in a normal populationÍ¾

Investigate other factors that many influence the length of the QT interval – age, sex, diurnal variation

Investigate QT hysteresis in a normal population. Our hypothesis is that about 1 to 3% of the normal population will have
an abnormal QT based on the QT nomogram. Little information is known about QT
hysteresis in the normal population but previous studies suggest it is on
average about 2 minutes.

The purpose of this project is to investigate the effectiveness and safety of early antivenom administration for the treatment of red-bellied black snake bites/envenoming. Red-bellied black snakebites are the most common in Eastern Australia and are not routinely treated with antivenom because they appear to cause minor effects and there is concern about the risk of allergic reactions to antivenom. However, recent work by the ASP investigators suggests that the early use of antivenom will reduce the chance of people developing muscle damage. This study is a randomised controlled trial of one vial of tiger snake antivenom compared to standard care (placebo) and this will provide good evidence for or against the early administration of antivenom for muscle damage. The study will also investigate whether antivenom neutralises other effects of RBBS envenoming and determine the frequency of allergic reactions, including anaphylaxis, after antivenom use.

Randomised controlled trial of early antivenom administration in Australian snakebite 2015 -

Current standard practice for any snake bite requires laboratory testing to determine if a patient has been envenomed, and coagulation studies are the most important tests. The administration of antivenom is then based on the presence of clinical effects of envenoming and abnormal laboratory investigations. Many of these envenoming effects are irreversible, so once they develop they are unlikely to be reversed by antivenom. This means that, antivenom needs to be given prior to the development of irreversible envenoming syndromes. The aim of this project will be to administer antivenom early – as soon as the patient presents to hospital â without first waiting for laboratory tests or the development of clinical signs of envenoming (except nonâspecific symptoms), and/or retrieval to a major hospital for laboratory testing. The objective is to determine if the administration of early antivenom will prevent envenoming effects and therefore significant morbidity or death.